How to Save a Trillion Dollars

In the scheme of things, saving the 38 billion bucks that Congress seems poised to agree upon is not a big deal. A big deal is saving a trillion bucks. And we could do that by preventing disease instead of treating it.

But they’re preventable, and you prevent them the same way you cause them: lifestyle. A sane diet, along with exercise, meditation and intangibles like love prevent and even reverse disease. A sane diet alone would save us hundreds of billions of dollars and maybe more.

This isn’t just me talking. In a recent issue of the magazine Circulation, the American Heart Association editorial board stated flatly that costs in the U.S. from cardiovascular disease — the leading cause of death here and in much of the rest of the world — will triple by 2030, to more than $800 billion annually. Throw in about $276 billion of what they call “real indirect costs,” like productivity, and you have over a trillion. Enough over, in fact, to make $38 billion in budget cuts seem like a rounding error.
Similarly, Type 2 diabetes is projected to cost us $500 billion a year come 2020, when half of all Americans will have diabetes or pre-diabetes. Need I remind you that Type 2 diabetes is virtually entirely preventable? Ten billion dollars invested now might save a couple of hundred billion annually 10 years from now. And: hypertension, many cancers, diverticulitis and more are treated by a health care (better termed “disease care”) system that costs us about $2.3 trillion annually now — before costs double and triple.

The many numbers all point in the same direction. Look at heart disease: The INTERHEART study of 30,000 men and women in 52 countries showed that at least 90 percent of heart disease is lifestyle related; a European study of more than 23,000 Germans showed that people with healthier lifestyles had an 81 percent lower risk.

And those estimates might be on the low side. Dean Ornish, the San Francisco-based doctor who probably knows more about diet and heart disease than anyone, says, “My colleagues and I have found that more intensive diets than those studies used can reverse the progression of even severe coronary heart disease.”

In his latest book, “The Spectrum,” Ornish recommends that people at risk eat stricter diets (more plants, higher fiber, lower saturated fats and so on) than those who are generally healthy, but it’s not all or nothing — the more you change your diet and lifestyle, the healthier you are. “What matters most,” he says, “is your overall way of eating and living. If you indulge yourself one day, eat healthier the next.” I’ve been preaching similarly for years. But the trillion-dollar question is, “How do we get people to eat that way?”

I don’t have an easy answer; no one does. But it for sure will take an investment: it’s a situation in which you must spend money to make or save money. (Yes, taxes will go up, but whose taxes?) Some number of billions of dollars — something in the rounding error area — should be spent on research to figure out exactly how to turn this ship around. (The NIH, which pegs obesity-related costs at about $150 billion, just announced a new billion-dollar investment. Good, but not enough.)

Corny as it is to say so, if we can put a man on the moon we can create an environment in which an apple is a better and more accessible choice than a Pop-Tart. Some other billions of dollars must go to public health. Again: we built sewage systems; we built water supplies; we showed that we could get people to eat anything we marketed. Now all we have to do is build a food distribution system that favors real food, and market that.

Experts without vested interests in the status quo come to much the same conclusion: Only a massive public health effort can save both our health and our budget.

Can we afford it? Sure. Dr. David Ludwig, a Harvard-affiliated pediatrician and the author of “Ending the Food Fight,” says, “The magnitude of the deficit is small when you consider costs of nutrition-related disease; the $4 trillion that the Republicans want cut over a decade is about the same as the projected costs of diabetes over that same period.”

In last week’s issue of the Journal of the American Medical Association, Ludwig made a number of concrete suggestions, like restructuring subsidies, regulating the marketing of food to children and adequately funding school lunch programs.

His most novel ideas use existing and future technologies to help the food industry retain profits while producing less junky products: devising a method of preserving polyunsaturated fats, for example (dangerous trans-fats are widely used simply because they are stable) or making bread with real whole grains instead of refined ones. (His research demonstrates that people who eat ultra-processed grains rather than whole grains for breakfast go on to consume 600 to 700 calories more than other people each day.) “I’m not arguing that the food industry should be philanthropic,” he says. “Its purpose is to make money. But the goal of the government should be to encourage industry to make money by producing more rather than less healthful foods.”

The best way to combat diet-related diseases is to change what we eat. And if our thinking is along the lines of diet improved = deficit reduced, so much the better. If a better diet were to result only in a 10 percent decrease in heart disease (way lower than Ludwig believes possible), that’s $100 billion project savings per year by 2030.

This isn’t just fiscal responsibility, but social responsibility as well. And the alternative is not only fiscal catastrophe but millions of premature deaths.

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